CLEAR UEC and Flow Transformation Programme
Barking, Havering and Redbridge University Hospitals Trust
Improving same day emergency care for faster access and smoother patient flow
At a glance
The challenge
Increasing demand across urgent and emergency care pathways was placing pressure on patient flow, workforce capacity and service efficiency. Existing SDEC pathways required clearer processes, improved coordination and better use of clinical space.
Key changes
A redesigned mSDEC model established a protected same day emergency care service operating 8am–midnight, supported by improved estates, streamlined pathways, electronic records and a dedicated multidisciplinary workforce.
Forecast impact
Improved patient flow and faster access to care, with increased direct referrals into SDEC, reduced ED attendances, higher patient satisfaction and greater operational efficiency across urgent care pathways.
The challenge
BHRUT sought to improve same day emergency care by addressing increasing pressure across urgent and emergency care services.
Rising demand, inconsistent pathways and operational inefficiencies were impacting patient flow, timely access to care and pressure on ED services.
The project identified opportunities to improve estates, workforce coordination and operational processes to ensure patients were seen in the right place, first time.
The approach
Using CLEAR's five-stage approach — clinical engagement, data review, innovation, recommendations and implementation support — the project redesigned same day emergency care pathways using frontline insight and detailed service analysis.
52 staff were engaged and 430,058 patient records analysed. The redesign established mSDEC as a protected 8am–midnight service, supported by improved estates, streamlined processes, enhanced electronic records and a dedicated workforce model including senior nursing coordination.
Leadership and implementation support helped embed sustainable operational change and improve patient flow across services.
What we recommended
- Establish mSDEC as a protected same day emergency care service operating 8am–midnight, with admissions until 9pm and follow-ups from 8am
- Introduce clearer referral pathways and exclusion criteria to support consistent patient streaming
- Remodel SDEC estates to improve patient flow and maximise clinical space utilisation
- Develop a dedicated multidisciplinary workforce, including senior nursing coordination
- Improve operational processes to streamline referrals, investigations and discharge
- Expand the use of electronic patient records and chair-based care to improve throughput
- Strengthen direct referral pathways from GP, LAS and PELC services to reduce avoidable ED attendances
Forecast impact
The redesign delivered improved patient flow and faster access to care, with increased direct referrals into SDEC, reduced ED attendances, higher patient satisfaction and greater operational efficiency across urgent care pathways.
Patients are now seen in the right place, first time, with faster access and smoother care journeys, and pressure on ED services has reduced through improved same day emergency care pathways.
Early, tangible change
- Protected mSDEC operating model established across extended hours
- Improved direct access pathways into SDEC from community and urgent care services
- Enhanced coordination and patient oversight through dedicated workforce support
- More effective use of treatment spaces through chair-based care and estates redesign
- Streamlined referral and follow-up processes supporting smoother patient flow
- Increased use of digital records to improve operational efficiency and communication
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